The global organ transplant market appears to have reached a new low this week, with reports in The Guardian that one organ is sold every hour somewhere in the world. This follows a Chinese media exposé of young men selling kidneys for about $5,500 in Hangzhou. Organ trafficking is no longer the stuff of urban legend, it’s a grim reality.

According to the World Health Organization’s global organ transplant report, 106,879 organ transplants were performed worldwide in 2010. But this data doesn’t identify whether the organs were bought and sold. The WHO conservatively estimates the proportion of traded or trafficked organs is up to 10%, or roughly 11,000 in 2010. But the true figure could be much higher.

Kidneys are the most common organ transplanted, and much of the illegal organ market is likely to consist of kidneys from living “donors”. These people are motivated to sell by extreme poverty, yet they rarely see any long-term financial gains. Often, they receive less than they are promised by brokers; one Indian study showed the average payments is just $1,070, rather than the promised average of $1,410.

Vendors are often the breadwinner of their family, but the impact of selling a kidney on their physical and mental health frequently disables them from future work. They suffer social stigma and tend to regret their decision to sell.

Payment for organs not only increases supply, it also enables customers to avoid organ allocation systems in their own country and jump straight to the head of the queue. Wealth, rather than medical criteria, strongly determines how long you wait for an organ on the black market.

But purchasing transplants overseas is associated with a higher risk of serious complications, especially infections such as HIV and Hepatitis B. Studies of patients returning to Saudi Arabia, the United States, Turkey and Taiwan consistently demonstrate this risk, regardless of whether transplants were purchased in Pakistan, India or China.

China is a key player in the global organ market.SlapAyoda

Chinese organ trade

China has a large share of the global market largely because of its use of organs from executed prisoners. China’s unique ability to provide organs – including hearts and lungs – on demand from a pool of thousands of potential “donors” has led to a highly lucrative industry in which foreign patients pay up to US$200,000 for a liver transplant. In 2006, Chinese authorities reported performing 11,000 transplants.

Condemnation of the use of prisoner organs, in particular the alleged targeting of Falun Gong practitioners, has prompted gradual change in Chinese policy and practice. In March, the Ministry of Health pledged to abolish the prisoner program and promote the development of deceased donation programs .

Nevertheless, as the supply of organs from executed prisoners wanes, demand for organs from living providers increases, and the government has offered variable financial “rewards” to those providing consent for deceased “donation”. One family reportedly received 1600 yuan, roughly A$250, for consenting to the donation of their daughter’s organs.

In 2007, China prohibited the sale of organs to foreign patients. Since then, officials report transplants for foreigners have fallen, and countries such as Malaysia have noted a significant drop in transplants. But patients continue to be spotted returning to countries such as Spain, South Korea and the United States having undergone surgery in China.

Doctors who take care of transplant recipients when they return home can report this activity to organisations such as the Declaration of Istanbul Custodian Group.

One step forward

The Declaration of Istanbul on Organ Trafficking and Transplant Tourism was developed in 2008 in an attempt to curb international trade in organs and travel for commercial organ transplantation, known as “transplant tourism”. It provides ethical guidance for policy makers and doctors working in transplantation medicine.

Members of the Declaration’s Custodian Group and its emissaries gather reports of trafficking and illegal trade in organs and bring them to the attention of the relevant authorities, to prompt reform.

The Rocketeer

Over the past five years, Egypt, Pakistan and India have implemented new laws prohibiting organ trade. Israel and Malaysia have also removed financial supports for patients receiving transplants abroad in an effort to discourage the practice. Cases of organ trafficking have been prosecuted in Kosovo, the United States, South Africa, the United Kingdom, India and China.

But despite this progress, new markets have emerged to replace those temporarily shut down. Brokers relocate and organ vendors travel to new countries; wealthy foreign patients take advantage of residency laws to gain access to transplantation programs. And trade continues largely as usual in places such as Egypt and Pakistan, where law enforcement authorities have higher priorities.

Responsible solutions

The WHO estimates only 10% of global needs for organ transplantation are currently met. Some commentators suggest that the only way to meet needs and to eliminate the black market is to establish legal markets, at least for kidneys.

Others argue that legalisation will simply relocate the problems of existing markets and expand the trade.

The WHO and supporters of the Declaration of Istanbul believe the best solution involves:

developing better systems of deceased organ donation;

encouraging altruistic living kidney donation;

preventing needs for transplantation by treating diseases that lead to organ failure such as diabetes and hepatitis;

implementing laws that prohibit organ trading and trafficking.

To achieve these goals, countries must take responsibility for meeting their own transplant needs by pursuing self-sufficiency.

Australia has made valuable progress in recent years with the creation of the Organ and Tissue Authority and the work of the Donate Life Network, and the introduction this week of legislation criminalising organ trafficking.

In addition to focusing on the health of our own citizens and discouraging Australian involvement in the global market, we can curb the market by helping to address the extreme poverty in the countries where organ selling is endemic.